Infective endocarditis is microbial infection of the endovascular structures of the heart.
It often presents in an occult fashion and early diagnosis depends on a high index of clinical suspicion especially in patients with congenital heart disease, prosthetic valves or previous infective endocarditis.
The established diagnosis of infective endocarditis is demonstrated by a positive blood culture and involvement of the endocardium detected during sepsis or systemic infection. It may also be established if there is involvement of the endocardium detected during sepsis or systemic infection but blood culture is negative.

Imaging

Echocardiogram

Diagnostic test of choice in detecting vegetations in cardiac valves

Three Echocardiographic Findings Considered to be Major Criteria in the Diagnosis of IE

Mobile, echodense mass attached to the valvular or the mural endocardium esp if present on the preferred locations, or attached to implanted prosthetic material w/ no alternative anatomical explanation

Demonstration of abscesses or fistulas

A new dehiscence of a valvular prosthesis esp when occurring late after implantation